Burden of Chemotherapy-Induced Neuropathy in School ged children

• Author: Artan Shkoza Mirlinda Likmeta Ledjan Malaj
• Position: University of Medicine, Tirana, Albania
• Pages: 96-101

IIPCCL Publishing, Tirana-Albania

Academic Journal of Business, Administration, Law and Social Sciences Vol. 1 No. 3

November 2015

ISSN 2410-3918

Acces online at www.iipccl.org

96

Burden of Chemotherapy-Induced Neuropathy in School ged children

M. D, Artan Shkoza

University of Medicine, Tirana, Albania

Msc., Mirlinda Likmeta

University of Medicine, Tirana, Albania

M. D, PhD, Ledjan Malaj

University of Medicine, Tirana, Albania

Abstract

Chemotherapy-induced peripheral neuropathy (CIPN) is the most common neurological

complication in cancer treatment and probably the most common toxic neuropathy in our

environment. The aim of the study was to assess the incidence and discomfort caused by

neuropathic symptoms in children treated for hematologic cancers. The study included all

children admitted to the pediatric oncology service at the University Hospital Center “Mother

Teresa”, Tirana, by the year 2011 – 2013 divided in three diagnosis groups: acute lymphoblastic

leukemia, Hodgkin and non-Hodgkin’s lymphoma, or other solid tumors. In a prospective

cohort setting, data were collected by standard questionnaire for symptoms and signs of

neurological damage, according to The Pediatric - Modified Total Neuropathy Scale (Ped -

mTNS), as well as clinical evaluation of pin sensibility, vibration sensibility, muscle strength

and deep tendon reflexes (DTR). The results obtained from Ped-mTNS, showed the high

incidence of sensory and motor symptoms as well as functional deficits in balance and manual

dexterity in children treated with anticancer drugs. Ped-mTNS scores, as the first measure

designed to assess CIPN in school-aged children, are significantly higher for children

undergoing neurotoxic chemotherapy. Even though the neuropathy in these children was

relatively mild, it was associated with functional deficits in balance and manual dexterity,

suggesting clinical importance. An important limiting factor of this study is the exclusion of

children younger than 5 years old, whom discomfort is evident but not properly evaluated.

Keywords: Peripheral neuropathy, chemotherapy, toxicity in children.

Introduction

Many pediatric cancer diagnoses now have 5-year survival rates of over 85 % due to

the use of multimodal treatment that often includes chemotherapy (Ries et al., 1999,

99). Unfortunately, a number of chemotherapeutic medications have potential long

term effects, including neurotoxicity. In the peripheral nervous system (PNS), this

toxicity often manifests as chemotherapy-induced peripheral neuropathy (CIPN);

while in the central nervous system, toxicities range from cognitive and intellectual

impairments to encephalopathy and coma.

Symptoms of neurotoxicity in the PNS are often under-recognized and undiagnosed

in adult patients (Markman, 2006, 275). Even less is known about the prevalence and

impact of CIPN in pediatrics. One major reason for sparse data has been the lack of

specific and sensitive measurement tools for CIPN in the pediatric population. The

most neurotoxic chemotherapeutic agents are vinca alkaloids, cisplatin and its